Preparing The Hospital For Victims Of Hazmat & Terrorist Incidents

Fire departments, EMS providers and other emergency response agencies are being trained to deal with terrorist incidents, but recent testimony before Congress reveals that local public health systems are not prepared to respond to potential chemical or...

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Patient Management

A fire department, hazmat team, EMS crew or other responding agency will notify an emergency department that a patient or patients exposed to hazardous materials are enroute. This should set in motion a pre-planned course of action. Such a pre-plan calls for personnel to be aware of their responsibilities and how to perform them, and necessary equipment to be readily available or easily accessed.

Photo by Robert Burke
The interior of a hospital emergency department is covered with plastic to prevent contamination.

Emergency responders should provide the hospital with as much information as possible about the victim(s) before arrival, including:

  • Type and nature of incident.
  • Caller's telephone number.
  • Number of patients.
  • Signs/symptoms being experienced by patients.
  • Nature of injuries.
  • Name of chemical(s) involved.
  • Extent of patient decontamination in the field.
  • Estimated time of arrival.

EMS personnel should be notified if patient is to be brought to a special location or entrance to the emergency department to control potential contamination or to perform decontamination. Upon notification of a contaminated patient or patients in route, notifications are made according to the pre-plan, the decontamination area prepared and the decon team suited up.

Decontamination rooms should be well ventilated and, if possible, have ventilation systems that are separate from the rest of the hospital. Drains from the decontamination rooms should go to segregated holding tanks. These rooms should not contain sensitive equipment or supplies which could become contaminated and have to be trashed.

Prevention of contamination to the room should include protecting all door knobs, cabinet handles, light switches, and other areas where contamination may be spread. Floors should also be covered with plastic and taped to prevent slipping.

A basic decontamination setup should contain the following:

  • Location for patients to undergo decontamination.
  • Means to wash contaminants from patients.
  • Containment for the runoff.
  • Protection for personnel handling patients.
  • Medical equipment to treat patients that is washable or disposable.

Decontamination team members should be pre-designated and trained in the appropriate protective equipment and procedures. Team members should include emergency physicians, emergency department nurses and aides, and support personnel such as security officers, maintenance workers and biological safety officers.

When patients arrive at the hospital, they should be met by the emergency physician-in-charge or an emergency department nurse to assess their condition and degree of contamination. Triage procedures may be implemented, if needed. All contaminated clothing should be removed. Clothing will need to be double bagged in plastic, sealed and labeled.

If decontamination is necessary, the decon team should bring a prepared stretcher to the ambulance and transport the patient directly to the decon area. Open wounds should be protected to prevent them from being contaminated. Priority is always given to the ABCs (airway, breathing and circulation) while personnel conduct decontamination.

Effective decontamination involves a thorough washing of patients. The contaminant should be reduced to a level that is no longer a threat to patients or personnel.

Because victims may arrive at an emergency room on their own, the hospital must have the ability to conduct decontamination when needed and protect personnel before treatment can begin. Decontamination in the hospital setting can range from a typical decontamination line setup outside the emergency room or in the parking lot, to a dedicated decontamination room inside the hospital. In some cases, local hazmat teams may be called upon to set up decontamination outside emergency rooms.

Prepare For The Worst